Relationship between acute diarrhoea and low plasma levels of vitamin A and retinol binding protein

Velasquez-Melendez, Gustavo; Roncada, Maria José; Toporovski, Julio; Okani, Eliza T.; Wilson, Donald

doi:10.1590/S0036-46651996000500008

Abstracts

The objective of this study was to assess vitamin A status and association between acute diarrhoea and plasma levels of vitamin A through cross-sectional comparison in children. Plasma vitamin A was measured by colorimetric method of Neeld & Pearson and RBP by radial immunodiffusion technique. Seventy eight children (aged 18-119 months), 26 with current history of diarrhoea and 52 children as controls (outpatient from the Santa Casa de Misericórdia Hospital in metropolitan area of São Paulo City, Brazil) were studied. Children with history of diarrhoea showed significant low levels (mean ± s.e.) as compared to controls, vitamin A (15.87 ± 1.4 µg/dl vs. 21.14 ± 1.15 µg/dl, p < 0.007) and RBP (1.70 ± 0.2 mg/dl vs. 2.52 ±0.11 mg/dl). Multivariate logistic regression adjusted by sex, age, nutritional status and mother education revealed association between diarrhoea and inadequate levels of vitamin A and RBP.

Diarrhoea; Vitamin A; RBP; Hypovitaminosis A

O objetivo deste trabalho foi avaliar o estado nutricional relativo a vitamina A e a associação entre diarréia e os níveis plasmáticos de vitamina A e RBP através de um estudo transversal. A vitamina A foi medida pelo método de Neeld & Pearson e RBP pela técnica de imunodifusão radial. Foram estudadas 78 crianças (com idades entre 18 e 119 meses), 26 com diarréia e 52 como controles, atendidas na consulta ambulatorial do Hospital Santa Casa de Misericórdia de São Paulo, da Cidade de São Paulo. As crianças com diarréia mostraram níveis significativamente mais baixos de vitamina A (15.87 ± 1.4 µg/dl vs. 21.14 ± 1.15 µg/dl, p< 0.007) e RBP (1.70 ± 0.2 mg/dl v.s 2.52 ± 0.11 mg/dl) quando comparadas com as do grupo controle. As análises de regressão logística mostraram associação entre diarréia e níveis inadequados de vitamina A e RBP ajustados pelo sexo, idade, estado nutricional e nível de educação materna.

TROPICAL GASTROENTEROLOGY

Relationship between acute diarrhoea and low plasma levels of vitamin A and retinol binding protein

Relação entre diarréia aguda e baixos níveis plasmáticos de vitamina A e proteína carregadora de retinol (RBP)

Gustavo Velasquez-Melendez^I; Maria José Roncada^I; Julio Toporovski^II; Eliza T. Okani^I; Donald Wilson^III

^IDepartment of Nutrition, School of Public Health, University of São Paulo, Brazil

^IIDepartment of Pediatrics, Santa Casa de Misericórdia Medical School, São Paulo, Brazil

^IIIDepartment of Medicine, University of Maringá, Paraná, Brazil

^{Correspondence to} Correspondence to: Gustavo Velasquez-Meléndez Faculdade de Saúde Pública, Departamento de Nutrição Av. Dr. Arnaldo, 715 01246-904 Sao Paulo, SP, Brasil Fax 11-852.6748 E-mail: Melendez@usp.br

SUMMARY

The objective of this study was to assess vitamin A status and association between acute diarrhoea and plasma levels of vitamin A through cross-sectional comparison in children.

Plasma vitamin A was measured by colorimetric method of Neeld & Pearson and RBP by radial immunodiffusion technique.

Seventy eight children (aged 18-119 months), 26 with current history of diarrhoea and 52 children as controls (outpatient from the Santa Casa de Misericórdia Hospital in metropolitan area of São Paulo City, Brazil) were studied.

Children with history of diarrhoea showed significant low levels (mean ± s.e.) as compared to controls, vitamin A (15.87 ± 1.4 µg/dl vs. 21.14 ± 1.15 µg/dl, p < 0.007) and RBP (1.70 ± 0.2 mg/dl vs. 2.52 ±0.11 mg/dl).

Multivariate logistic regression adjusted by sex, age, nutritional status and mother education revealed association between diarrhoea and inadequate levels of vitamin A and RBP.

Keywords: Diarrhoea; Vitamin A; RBP; Hypovitaminosis A.

RESUMO

O objetivo deste trabalho foi avaliar o estado nutricional relativo a vitamina A e a associação entre diarréia e os níveis plasmáticos de vitamina A e RBP através de um estudo transversal.

A vitamina A foi medida pelo método de Neeld & Pearson e RBP pela técnica de imunodifusão radial.

Foram estudadas 78 crianças (com idades entre 18 e 119 meses), 26 com diarréia e 52 como controles, atendidas na consulta ambulatorial do Hospital Santa Casa de Misericórdia de São Paulo, da Cidade de São Paulo.

As crianças com diarréia mostraram níveis significativamente mais baixos de vitamina A (15.87 ± 1.4 µg/dl vs. 21.14 ± 1.15 µg/dl, p< 0.007) e RBP (1.70 ± 0.2 mg/dl v.s 2.52 ± 0.11 mg/dl) quando comparadas com as do grupo controle. As análises de regressão logística mostraram associação entre diarréia e níveis inadequados de vitamina A e RBP ajustados pelo sexo, idade, estado nutricional e nível de educação materna.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENT

The Authors wish to thank the staff at the Department of Pediatrics of Santa Casa de Miscricórdia de São Paulo their cooperation; Levino Triebess from Hoechst do Brasil for donating RBP plates; Dina Yaeko Uchara and Dr. Francisco Carrazza both from Child Institute of School of Medicine USP for her technical assistance in RBP determinations and suggestions, respectively; Dr. Sergio Muñoz from Temuco University, Chile by suggestions in statistical analysis and Sueli Gimeno for critical review.

Recebido para publicação em 18/07/1996

Aceito para publicação em 25/09/1996

Sponsorship: CNPq (30072/94-3).

1. ALVAREZ, J.O.; SALAZAR-LINDO, E.; KOHATSU, J.; MIRANDA, P. & STEPHENSEN, C. - Urinary excretion of retinol in children with acute diarrhoea. Amer. J. clin. Nutr., 61: 1273-1276, 1995.
2. BARRETO, M.L.; SANTOS, L.M.P.; ASSIS, A.M.O. el al. - Effect of vitamin A supplementation on diarrhoea and acute-lower-tract infections in young children in Brazil. Lancet, 344: 228-231, 1994.
3. BUYUKGEBIZ, B.; OZALP, I & ORAN, O. - Investigation of serum vitamin A levels of children who had history of recurrent diarrhoea and acute respiratory infections in Ankara. J. trop. Pediat., 36: 252-255, 1990.
4. CHENG LIE; CHANG YING; WANG EN-LIN: BRUN, T & GEISSLER, C. - Impact of large doses of vitamin A supplementation on childhood diarrhoea, respiratory disease and growth. Europ. J. clin. Nutr., 47: 88-96, 1992.
5. COUTSOUDIS, A.; COOVADIA, H.M.; BROUGHTON, M.; SALISBURY, R.T. & ELSON, I. - Micronutrient utilization during measles treated with vitamin A or placebo. Int. J. vit. Nutr. Res., 61: 199-204, 1991.
6. EL BUSHRA, H.E.; ASH, L.R.; COULSON, A.H. & NEUMANN, C.G. - Interrelationship between diarrhoea and vitamin A deficiency: is vitamin A deficiency a risk factor for diarrhoea? Pediat. infect. Dis., 11: 380-384, 1992.
7. FEACHEM, R.G. - Vitamin A deficiency and diarrhoea: a review of interrelationships and their implications for the control of xerophthalmia and diarrhoea. Trop. Dis. Bull., 84: R1-R15, 1987.
8. FRIEDEN, T.R.; SOWELL, A.L.; HENNING, K.J.; JUFF, D.L. & GUNN, R.A. - Vitamin A levels and severity of measles (New York City). Amer. J. Dis. Child, 146: 182-186, 1992.
9. FILTEAU, S.M.; MORRIS, S.S.; ABBOTT, R.A. et al. - Influence of morbidity on serum retinol of children in a community-based study in Northern Ghana. Amer. J. clin. Nutr., 58: 192-197, 1993.
10. MANCINI, G.; CARBONARA, A.O. & HEREMANS, J.F. - lmmunochemical quantification of antigens by single radial immunodiffusion. Immunochemistry, 2: 235-254, 1965.
11. NEELD, J.B. & PEARSON, W.N. - Macro and micro methods for the determination of serum vitamin A using trifluoroacetic acid. J. Nutr., 79: 454-462, 1963.
12. PENG, Y.M.; XU, M.J. & ALBERTS, D.S. - Analysis and stability of retinol in plasma. J. nat. Cancer Inst., 78: 95-99, 1987.
13. RAHMATHULLAH, L.; UNDERWOOD, B.A.; THULASIRAJ, R.D. et al. - Reduced mortality among children in Southern India receiving a small weekly dose of vitamin A. New Engl. J. Med., 323: 929-935, 1990.
14. RAHMATHULLAH, L.; UNDERWOOD, B.A.; THULASIRAJ, R.D. & MILTON, R.C. - Diarrhoea, respiratory infections and growth are not affected by a weekly low dose vitamin A supplement: a masked, controlled field trial in Southern India. Amer. J. clin. Nutr., 54: 508-577, 1991.
15. SALAZAR-LINDO, E.; SALAZAR, M. & ALVAREZ, J.O. - Association of diarrhoea and low serum retinol in Peruvian children. Amer. J. clin. Nutr., 58: 110-113, 1993.
16. SAMBA, C.; GALAN, P.; LUZEAU, R. & AMEDEE-MANESME, O. - Vitamin A deficiency in pre-school age Congolese children during malarial attacks. Part I: utilization of the impression cytology with transfer in a equatorial country. Int. J. vit. Nutr. Res., 60: 215-223, 1989.
17. SNYDER, J.D. & MERSON, M.H. - The magnitude of the global problem of acute diarrhoea disease: a review of active surveillance data. Bull. Wld. Hlth. Org., 60: 605-613, 1982.
18. SOMMER, A.; KATZ, J. & TARWOTJO, I. - Increased risk of respiratory disease and diarrhoea in children with preexisting mild vitamin A deficiency. Amer. J. clin. Nutr., 40: 1090-1095, 1984.
19. SOMMER. A.; TARWOTJO, I. & KATZ, J. - Increased risk of xerophthalmia following diarrhoea and respiratory disease. Amer. J. clin. Nutr., 45: 977-980, 1987.
20. STEPHENSEN, C.B.; ALVAREZ, J.O.; KOHATSU. J. et al. - Vitamin A is excreted in the urine during acute infection. Amer. J. clin. Nutr., 60: 388-392, 1994.
21. TIELSCH, J.M.; WEST Jr., K.P.; KATZ, J. et al. - Prevalence and severity of xerophthalmia in Southern Malawi. Amer. J, Epidem., 124: 561-568, 1986.
22. VELASQUEZ-MELENDEZ, J.G.; OKANI, E.T.; KIERTSMAN, B. & RONCADA, M.J. - Vitamin A status in children with pneumonia, Europ. J. clin. Nutr., 49: 379-384, 1995.
23. VELASQUEZ-MELENDEZ, G.; OKANI, E.T.; KIERTSMAN, B. & RONCADA. M.J. - Níveis plasmáticos de vitamina A. carotenóides e proteína ligadora de retinol em crianças com infecçőes respiratórias agudas e doenças diarréicas. Rev. Saúde públ. (S. Paulo), 28: 357-364, 1994.
24. VIJAYARAGHAVAN, K.; RADHAIAH, G.; PRAKASAM, B.S.; RAMESHWAR SARMA, K.V. & REDDY, V. - Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet, 336: 1342-1345, 1990.
25. WEST Jr., K.P.; POKHREL, R.P.; KATZ, J. et al. - Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet,338: 67-71, 1991.
²⁶
WORLD HEALTH ORGANIZATION - Measuring change in nutritional status. Geneve, 1983.
27. WORLD HEALTH ORGANIZATION, UNITED NATION CHILDREN'S FUND - Indicadores usados para vigilar la deficiencia de vitamina A. Bol. Ofic. sanit. panamer., 117: 567-573, 1994.

Correspondence to:

Gustavo Velasquez-Meléndez

Faculdade de Saúde Pública, Departamento de Nutrição

Av. Dr. Arnaldo, 715

01246-904 Sao Paulo, SP, Brasil

Fax 11-852.6748

E-mail:

Melendez@usp.br

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Oct 1996

History

Accepted
25 Sept 1996
Received
18 July 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALVAREZ, J.O.; SALAZAR-LINDO, E.; KOHATSU, J.; MIRANDA, P. & STEPHENSEN, C. - Urinary excretion of retinol in children with acute diarrhoea. Amer. J. clin. Nutr., 61: 1273-1276, 1995.

[2] 2. BARRETO, M.L.; SANTOS, L.M.P.; ASSIS, A.M.O. el al. - Effect of vitamin A supplementation on diarrhoea and acute-lower-tract infections in young children in Brazil. Lancet, 344: 228-231, 1994.

[3] 3. BUYUKGEBIZ, B.; OZALP, I & ORAN, O. - Investigation of serum vitamin A levels of children who had history of recurrent diarrhoea and acute respiratory infections in Ankara. J. trop. Pediat., 36: 252-255, 1990.

[4] 4. CHENG LIE; CHANG YING; WANG EN-LIN: BRUN, T & GEISSLER, C. - Impact of large doses of vitamin A supplementation on childhood diarrhoea, respiratory disease and growth. Europ. J. clin. Nutr., 47: 88-96, 1992.

[5] 5. COUTSOUDIS, A.; COOVADIA, H.M.; BROUGHTON, M.; SALISBURY, R.T. & ELSON, I. - Micronutrient utilization during measles treated with vitamin A or placebo. Int. J. vit. Nutr. Res., 61: 199-204, 1991.

[6] 6. EL BUSHRA, H.E.; ASH, L.R.; COULSON, A.H. & NEUMANN, C.G. - Interrelationship between diarrhoea and vitamin A deficiency: is vitamin A deficiency a risk factor for diarrhoea? Pediat. infect. Dis., 11: 380-384, 1992.

[7] 7. FEACHEM, R.G. - Vitamin A deficiency and diarrhoea: a review of interrelationships and their implications for the control of xerophthalmia and diarrhoea. Trop. Dis. Bull., 84: R1-R15, 1987.

[8] 8. FRIEDEN, T.R.; SOWELL, A.L.; HENNING, K.J.; JUFF, D.L. & GUNN, R.A. - Vitamin A levels and severity of measles (New York City). Amer. J. Dis. Child, 146: 182-186, 1992.

[9] 9. FILTEAU, S.M.; MORRIS, S.S.; ABBOTT, R.A. et al. - Influence of morbidity on serum retinol of children in a community-based study in Northern Ghana. Amer. J. clin. Nutr., 58: 192-197, 1993.

[10] 10. MANCINI, G.; CARBONARA, A.O. & HEREMANS, J.F. - lmmunochemical quantification of antigens by single radial immunodiffusion. Immunochemistry, 2: 235-254, 1965.

[11] 11. NEELD, J.B. & PEARSON, W.N. - Macro and micro methods for the determination of serum vitamin A using trifluoroacetic acid. J. Nutr., 79: 454-462, 1963.

[12] 12. PENG, Y.M.; XU, M.J. & ALBERTS, D.S. - Analysis and stability of retinol in plasma. J. nat. Cancer Inst., 78: 95-99, 1987.

[13] 13. RAHMATHULLAH, L.; UNDERWOOD, B.A.; THULASIRAJ, R.D. et al. - Reduced mortality among children in Southern India receiving a small weekly dose of vitamin A. New Engl. J. Med., 323: 929-935, 1990.

[14] 14. RAHMATHULLAH, L.; UNDERWOOD, B.A.; THULASIRAJ, R.D. & MILTON, R.C. - Diarrhoea, respiratory infections and growth are not affected by a weekly low dose vitamin A supplement: a masked, controlled field trial in Southern India. Amer. J. clin. Nutr., 54: 508-577, 1991.

[15] 15. SALAZAR-LINDO, E.; SALAZAR, M. & ALVAREZ, J.O. - Association of diarrhoea and low serum retinol in Peruvian children. Amer. J. clin. Nutr., 58: 110-113, 1993.

[16] 16. SAMBA, C.; GALAN, P.; LUZEAU, R. & AMEDEE-MANESME, O. - Vitamin A deficiency in pre-school age Congolese children during malarial attacks. Part I: utilization of the impression cytology with transfer in a equatorial country. Int. J. vit. Nutr. Res., 60: 215-223, 1989.

[17] 17. SNYDER, J.D. & MERSON, M.H. - The magnitude of the global problem of acute diarrhoea disease: a review of active surveillance data. Bull. Wld. Hlth. Org., 60: 605-613, 1982.

[18] 18. SOMMER, A.; KATZ, J. & TARWOTJO, I. - Increased risk of respiratory disease and diarrhoea in children with preexisting mild vitamin A deficiency. Amer. J. clin. Nutr., 40: 1090-1095, 1984.

[19] 19. SOMMER. A.; TARWOTJO, I. & KATZ, J. - Increased risk of xerophthalmia following diarrhoea and respiratory disease. Amer. J. clin. Nutr., 45: 977-980, 1987.

[20] 20. STEPHENSEN, C.B.; ALVAREZ, J.O.; KOHATSU. J. et al. - Vitamin A is excreted in the urine during acute infection. Amer. J. clin. Nutr., 60: 388-392, 1994.

[21] 21. TIELSCH, J.M.; WEST Jr., K.P.; KATZ, J. et al. - Prevalence and severity of xerophthalmia in Southern Malawi. Amer. J, Epidem., 124: 561-568, 1986.

[22] 22. VELASQUEZ-MELENDEZ, J.G.; OKANI, E.T.; KIERTSMAN, B. & RONCADA, M.J. - Vitamin A status in children with pneumonia, Europ. J. clin. Nutr., 49: 379-384, 1995.

[23] 23. VELASQUEZ-MELENDEZ, G.; OKANI, E.T.; KIERTSMAN, B. & RONCADA. M.J. - Níveis plasmáticos de vitamina A. carotenóides e proteína ligadora de retinol em crianças com infecçőes respiratórias agudas e doenças diarréicas. Rev. Saúde públ. (S. Paulo), 28: 357-364, 1994.

[24] 24. VIJAYARAGHAVAN, K.; RADHAIAH, G.; PRAKASAM, B.S.; RAMESHWAR SARMA, K.V. & REDDY, V. - Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet, 336: 1342-1345, 1990.

[25] 25. WEST Jr., K.P.; POKHREL, R.P.; KATZ, J. et al. - Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet,338: 67-71, 1991.

[26] ²⁶
WORLD HEALTH ORGANIZATION - Measuring change in nutritional status. Geneve, 1983.

[27] 27. WORLD HEALTH ORGANIZATION, UNITED NATION CHILDREN'S FUND - Indicadores usados para vigilar la deficiencia de vitamina A. Bol. Ofic. sanit. panamer., 117: 567-573, 1994.